City of Berkeley Mental Health Mental Health Services Act (MHSA) FY Annual Update

Transcription

1 City of Berkeley Mental Health Mental Health Services Act (MHSA) FY Annual Update

2 TABLE OF CONTENTS Background and Overview..1 Message From The Mental Health Manager 4 Demographics 5 Community Program Planning (CPP) 9 MHSA Fiscal Year (FY) 2018/ Program Descriptions and FY17 Data By Funding Component..17 -Community Services & Supports.18 -Prevention & Early Intervention Innovations..56 -Workforce, Education & Training.59 -Capital Facilities and Technological Needs...61 FY17 Average Cost Per Client..62 Budgets.1A Public Comments 1B i

3 BACKGROUND AND OVERVIEW California voters passed Proposition 63, the Mental Health Services Act (MHSA), in November 2004, to expand and transform the public mental health system. This legislation places a 1% tax on personal incomes above $1 million dollars. Funds are deposited into the MHSA State Treasury Fund and allocations per each mental health jurisdiction are determined based on the total population in a given area. Through the following five funding components, the MHSA was designed to create the capacity for a broad continuum of prevention, early intervention and treatment services along with the necessary infrastructure, technology, and training elements to support effective mental health system transformation: Community Services & Supports (CSS): Primarily provides treatment services and supports for Severely Mentally Ill Adults and Seriously Emotionally Disturbed Children. Prevention & Early Intervention (PEI): For strategies to recognize early signs of mental illness and to improve early access to services and programs, including the reduction of stigma and discrimination and for strategies to prevent mental illness from becoming severe and disabling. Innovations (INN): For short-term pilot projects designed to increase new learning in the mental health field. Workforce, Education & Training (WET): Primarily for strategies to identify and remedy mental health occupational shortages, promote cultural competency and the employment of mental health consumers and family members in the workplace. Capital Facilities and Technological Needs (CFTN): For capital projects on owned buildings and on mental health technology projects. Among other things, the MHSA provides enhanced services and supports for Seriously Emotionally Disturbed children and Transition Age Youth (TAY), adults, and older adults suffering from Severe Mental Illness through a no wrong door approach and aims to move public mental health service delivery from a disease oriented system to one that is culturally responsive, consumer informed, and wellness recovery oriented. This is accomplished through implementing programs that focus on the following major components: Wellness, recovery and resilience; Cultural competency; Consumer/family driven services; Consumer/family member integration in the mental health system; and Community collaboration. 1

4 The MHSA also strives to improve and increase services and supports for individuals and families from cultural and ethnic populations that are traditionally unserved and underserved in the mental health system. In Berkeley and Albany these have included: Asian Pacific Islanders (API); Latinos; Lesbian, Gay, Bi-Sexual, Transgender, Queer/Questioning, Inter-Sexed (LGBTQI); Senior Citizens; and Transition Age Youth (TAY). African Americans have been an additional population of focus as data indicates they are overrepresented in the mental health system and hence inappropriately served, which could be due to being provided services that are not culturally responsive and/or appropriate. In order to access MHSA funds, a stakeholder informed plan outlining how funds will be utilized must be developed and locally approved. Development of a MHSA Plan includes: community program planning with the involvement of area stakeholders, writing a draft plan, initiating a 30- day public review, conducting a public hearing at the Mental Health Commission meeting, and obtaining approval on the plan from City Council. The Community Services & Supports, Prevention & Early Intervention, and Innovation funding components are the only re-occurring monies that are allocated annually and may be spent over a three-year time period. Workforce, Education & Training and Capital Facilities and Technological Needs funds had initial expenditure time periods of 10 years each, and had to be utilized by the end of Fiscal Year 2018 (FY18). The MHSA legislation requires mental health jurisdictions to provide updates on MHSA Plans on an annual basis and beginning in FY15, an integrated Program and Expenditure Plan must also be developed every three years. Currently, the City of Berkeley Mental Health (BMH) Division has an approved MHSA FY2017/ /20 Three Year Program and Expenditure Plan (Three Year Plan) in place which covers each funding component. Since 2006, as a result of the City s approved MHSA plans, a number of new services and supports have been implemented to address the various needs of the residents of Berkeley and Albany including the following: Intensive services for Children, TAY, Adults and Older Adults; Multi-Cultural Outreach engagement, trainings, projects and events; Mental health services and supports for homeless TAY; Wellness Recovery services and activities; Family Advocacy, Housing services and supports, and Benefits Advocacy; Trauma services and short term projects to increase service access and/or improve mental health outcomes for unserved, underserved and inappropriately served populations; Increased mental health prevention, and intervention services for children and youth in area schools and communities; Augmented Homeless Outreach and treatment services; A Transitional Outreach Team; and Mental Health Consumer, Peer Leadership Program. 2

5 Additionally, an outcome of the implementation of the MHSA is that mental health consumers, family members and other stakeholders now regularly serve on several of BMH internal decision making committees. These individuals share their lived experience and provide valuable input which has become an integral component that informs the Division on the implementation of MHSA services and supports. Even prior to the passage of Proposition 63, BMH convened (and has since maintained) an MHSA Advisory Committee which serves in an advisory capacity on MHSA programs and is comprised of mental health consumers, family members, and individuals from unserved, underserved and inappropriately served populations, among other community stakeholders. This City of Berkeley MHSA FY2018/19 (FY19) Annual Update is a stakeholder informed plan that provides an update to the previously approved Three Year Plan. The Annual Update summarizes proposed program changes and additions, includes descriptions of currently funded MHSA services, and provides a reporting on FY17 program data. 3

6 MESSAGE FROM THE MENTAL HEALTH MANAGER The City of Berkeley s MHSA 2018/19 Plan includes continued expansion of services in areas that have been highlighted by stakeholders it increases the capacity to serve the most in need residents of Berkeley and Albany; it increases funding for supportive housing; it increases funding for Asian and Pacific Islander individuals and families, a population that is currently underserved; and it expands the ability of the mental health division to effectively monitor the outcomes of the programs it funds. The plan also continues funding an array of program and projects that have effectively served the residents of Berkeley and Albany in the past. The system of care is focused on providing services that are welcoming, culturally appropriate, and recovery oriented. While this continued expansion of services will increase the capacity to serve more individuals and families, there remains a significant gap between the community s needs and the ability for the mental health division and the contractors it funds to meet those needs. The continued high rates of individuals with mental health concerns that remain homeless, the continued high rates of hospitalization and 5150 s; and the continued disparities of mental health outcomes for African=American all are evidence that there remains a huge amount of work to be done to meet the needs of all the residents of Berkeley and Albany. This plan continues to support ongoing partnerships with Berkeley Unified School District, the City of Albany, the City of Berkeley s 2020 Vision: Equity in Education Project, and the Alameda County Behavioral Health Care System in an effort to leverage the efforts and funding of the mental health division to support the residents of Berkeley and Albany. The plan also significantly increases the ability of BMH to utilize Results Based Accountability in all division programs to ensure that outcomes are transparent and that funded programs are effective. The mental health division presents the City of Berkeley s MHSA 18/19 with pride and gratitude for all the hard work that went into the programs it describes. Our community partners, consumers, stakeholders and City staff all deserve appreciation for their efforts, input, and partnership. 4

7 DEMOGRAPHICS* *United States Census American Fact Finder: Description Situated in the heart of the San Francisco Bay area, and home to the University of California, Berkeley is an urban city, located in northern Alameda County. Adjacent to Berkeley and bordering Contra Costa County is the small suburban city of Albany. With a combined land mass of around 12.2 miles and a total population of 142,467 the cities of Berkeley and Albany are densely populated and larger than 23 of California s small counties. Race/Ethnicity Berkeley and Albany are diverse communities with changing demographics. In each city the African American population has decreased in recent years while the Latino and Asian populations have both increased. Both cities have large student populations, including Albany Village, providing housing for many of University of California s foreign students and their families. Threshold languages include English, Spanish, Farsi, Cantonese, and Vietnamese, and approximately 28% of Berkeley and 40% of Albany residents speak a language other than English at home. Each city is comprised of the following racial and ethnic demographics: White; African American; Asian; Hispanic/Latino; American Indian/Alaska Native; and Native Hawaiian/Pacific Islander (P.I.). Demographics per city are outlined below: Am. Indian/ Alaska Native <1% Hispanic/ Latino 11% City of Berkeley Race/Ethnicity N. Hawaiian/ P. I., <1% Asian 20% African American 8% White 61% Am. Indian/ Alaska Native 1% Hispanic/ Latino 13% City of Albany Race/Ethnicity N. Hawaiian/ P. I., 1% Asian 27% African American 4% White 54% 5

8 Age/Gender As depicted in the tables below, a large percentage of individuals in Berkeley and Albany are over the age of 18 and per population, Albany has twice as many individuals under the age of 18 as the City of Berkeley: City of Berkeley Age City of Albany Age 88% 75% 25% 12% Under & Over Under & Over Gender demographics are very similar in both cities as shown below: City of Berkeley Gender City of Albany Gender 51% 49% 51% 49% Females Males Females Males 6

9 Lesbian, Gay, Bisexual, Transgender, Queer (LBGTQ) Population Based on a Gallop Survey of interviews conducted during the timeframe of , the San Francisco bay area has the highest LGBTQ population (6.2%) of any of the top 50 United States metropolitan areas. Additionally according to Williams Institute, in a survey of Cities with 50+ same-sex couples (ranked by same-sex couples per 1,000 households) conducted in 2010, the City of Berkeley ranked number 13 in the State of California and number 48 among 1,415 United States cities. The City of Berkeley had 2.1% same-sex households according to the 2010 United States Census and the City of Albany had 1.7% same-sex households. Income/Housing With some of the highest housing costs in the Bay Area, the Berkeley median household income is $70,393, and Albany is $85,458. Nearly 20% of Berkeley and 11% of Albany residents live below the poverty line and approximately 42% of Berkeley and 35% Albany children qualify for free and reduced lunches. While 43% of Berkeley and 48% of Albany residents own their own homes, there are many homeless individuals including women, TAY, and Older Adults. In Berkeley, approximately 46% of the homeless population meets the federal definition for chronic homelessness (adults unaccompanied by children, who have at least one disability and have been homeless for over a year or four or more times in the last year). This is a disproportionately high percentage compared to other municipalities, and a subgroup with higher rates of both mental illness and substance abuse. Education Berkeley and Albany have a highly educated population: 97% of individuals aged 25 or older are high school graduates; and approximately 72% possess a bachelor s degree or higher. System Organization Berkeley Mental Health (BMH), one of two city-based public mental health programs in the state, provides services for residents of Berkeley and Albany. It is a Division of the City of Berkeley Health, Housing & Community Services (HHCS) Department. Services are provided at multiple clinic sites and in the field. BMH has several units providing services: Access; Family, Youth & Children; and Adult Services. Services include: assessment, assertive community treatment, individual and group therapy, case management and crisis intervention. In addition to offering homeless outreach and support, some services are provided through a variety of community-based agencies and at school sites. As part of the Access unit, a Mobile Crisis response Team operates seven days a week. The majority of mental health services provided by BMH are aimed towards the Medi-Cal and uninsured population; as such it is important to note the ways in which the Medi-Cal population demographics differ from the overall demographics in Berkeley and Albany. Using data available from Alameda County, the Medi-Cal population in Berkeley in 2017 was as follows: 7

10 City of Berkeley 2017 Medi-Cal Race/Ethnicity Hispanic/Latino 2,255/12% Alaska Native/Am. Ind. 64\<1% API 2,169/12% White 5,380/29% Other/Unknown 4,394/23% African American 4,556/24% White African American Other/Unknown API Hispanic/Latino Native American City of Albany 2017 Medi-Cal Race/Ethnicity Hispanic/Latino 413/13% Alaska Native/Am. Ind. 7\<1% API 969/31% White 747/24% African American 173/5% Other/Unknown 866/27% White African American Other/Unknown API Hispanic/Latino Alaska Native/American Indian 8

11 Community Program Planning (CPP) Community Program Planning (CPP) for the City of Berkeley s MHSA FY2018/19 (FY19) Annual Update was conducted over a two month period enabling opportunities for input from the MHSA Advisory Committee members, consumers, family members, representatives from communitybased organizations, individuals from unserved, underserved and inappropriately served populations, BMH Staff, City Commissioners, and other MHSA Stakeholders. During this process, two MHSA Advisory Committee meetings and four Community Input meetings were held. As with previous MHSA Plans and Annual Updates, the methodology utilized for conducting CPP for the MHSA FY19 Annual Update was implemented to enable a collaborative process to occur between BMH staff, MHSA Advisory Committee members and other MHSA stakeholders. Development of the MHSA FY19 Annual Update began with an internal examination of existing programs, unaddressed needs, and available funding which included a review of input received during the preparation of previous MHSA planning processes. Following an internal review, proposed ideas and potential programs were vetted through the MHSA Advisory Committee prior to engaging other stakeholders. Proposed additions that were considered in this process included: increased case management for TAY and women; enhanced shelter supports; additional services for Asian Pacific Islanders; funding for both an Evaluation Consultant and an Innovation Consultant, increased funding for services in Albany and for the Russell Street Residence; additional BMH nursing, clinical and administrative staffing; monies to support construction costs for the Wellness Recovery Center; enhanced funding for Flex Funds for BMH Clients; funding for the High School Mental Health Peer Education Program; allocation of another year of funds to California Mental Health Services Authority (CalMHSA) for local involvement in PEI Statewide projects; and increase in funds for the Wellness Recovery Program. Community input received during the CPP for the proposed additions was largely favorable. Input received during the CPP focused on requests for the following: training and working with staff at Board & Care facilities on how to provide low cost highly nutritious meals; providing strength based approaches for residents at Board & Care facilities or at other sites that residents regularly frequent to help promote confidence and a higher social skill level; enhancing mental health staffing in the schools; additional wellness recovery activities such as sports, recreation, rap groups, drumming, and other music programs. The Division took additional time to assess which programs should be added to ensure this FY19 Annual Update includes the right level of expenditures that will enable programs to be sustained, while avoiding the risk of reversion. As such, some but not all proposed programs and additions were included. Proposed services and additions that were not included will be re-visited for possible inclusion to be funded through future MHSA Plans. As per MHSA plan requirements, this FY19 Annual Update, reports on data from FY17, (data from two years prior to FY19). While some MHSA programs have collected outcome and client self-report measures, the majority of the data is more process related. However, as previously reported in the MHSA FY2017/ /20 Three Year Program and Expenditure Plan (Three 9

12 Year Plan), there are a few initiatives that are currently underway to evaluate the outcomes of several MHSA programs including the following: Impact Berkeley: In the past year, the City of Berkeley s HHCS Department began the roll-out of Results Based Accountability in various Public Health and Mental Health programs. Through this initiative the Department envisioned, clarified and developed a common language about the outcomes and results each program is seeking to achieve, and used a rigorous framework to begin measuring and enhancing progress towards these results. The first part of the roll-out included the Children s Full Service Partnership and the MHSA CSS and PEI funded community agency programs. It is anticipated that the first year report on this initiative will be released in early Homeless Outreach & Treatment Team: This pilot program supports homeless mentally ill individuals in Berkeley/Albany engaging them in mental health services. A local consultant, Resource Development Associates, has been hired to measure the outcomes and effectiveness of this pilot project. An evaluation report will be provided mid-way and at the end of this three year pilot project. Trauma Informed Care Project: Funded through the Innovations component, this pilot project has implemented Trauma Informed Care (TIC) Training and supports for educators in three Berkeley Unified School District (BUSD) schools including Franklin Preschool, Berkeley Arts Magnet Elementary School and Willard Middle School. The project is being evaluated by Hatchuel Tabernik & Associates who have created and implemented a data collection and evaluation plan designed to report on program outcomes and evaluate the INN learning questions. The Evaluators first year report is part of the City of Berkeley Mental Health Services Act (MHSA) Fiscal Year 2017 Innovations Evaluation Report, which is located on the City of Berkeley Mental Health Division MHSA website. INN Data Outcomes: Per new MHSA INN regulations, all INN funded programs have to collect additional state identified outcome measures and detailed demographic information. The first report that includes data specific to the new INN requirements, City of Berkeley Mental Health Services Act (MHSA) Fiscal Year 2017 Innovations Evaluation Report, is located on the City of Berkeley Mental Health Division MHSA website. The next round of INN programs to be funded will also have provisions for evaluation to be an integral part of the project. PEI Data Outcomes: Per new MHSA PEI regulations, all PEI funded programs have to collect additional state identified outcome measures (specific to the category of services provided) as well as detailed demographic information. The first report that includes data specific to the new PEI requirements, City of Berkeley Mental Health Services Act (MHSA) Fiscal Year 2017 Prevention & Early Intervention Evaluation Report is located on the City of Berkeley Mental Health Division MHSA website. All PEI contracted programs have also been participating in the HHCS Department s Impact Berkeley initiative. Future MHSA Plans and updates will include reporting on the progress of these initiatives. Additionally, the Division has been evaluating input received around additional strategies to obtain program outcomes and through this FY19 Annual Update is proposing to add funding for a Consultant who could implement an RBA Evaluation for all programs across the Mental Health Division. 10

13 A 30-Day Public Review was held from Wednesday, August 29, through Thursday, September 27, 2018 to invite input on this MHSA FY2018/19 Annual Update. A copy of the Plan was posted on the BMH MHSA website and available for reviewing in hard copy format at the downtown Public Library at 2090 Kittredge Street. An announcement of the 30-Day Public Review was mailed and/or ed to community stakeholders. On the evening of September 27, 2018 a Public Hearing was held at the Mental Health Commission meeting. Staff answered questions regarding various programs in the FY19 Annual Update during the 30-Day Public Review and the Public Hearing. Input received during the 30-Day Public Review and/or the Public Hearing included the following: According to one MHSA funded contractor, outreach is a very important component of how the PEI project works with individuals. Cultural humility and cultural responsive services are hugely important and complicated, and this should be considered when attempting to get a consultant for cultural humility. Social and recreational activities and healthy food choices at Board & Care facilities would be a good idea. The color schemes on each race and ethnicity should be consistent across the various charts in the Demographics section of this Annual Update. The following additional comments were made by one MHSA stakeholder. A full description of each comment is included in the appendix: MHSA is fragmented among the 58 counties and 2 cities. Most of money is spent on a tiny fraction of people with Serious Mental Illness (SMI) and/or Substance Use Disorders (SUD) for Medi-Cal. Likely changes in the MHSA funding stream from CSS to PEI. Likely emphasis on providing supportive housing for people with SMI and/or SUD. State legislation focused on conservatorship and expanding the definition of grave disabled (in addition to Laura s Law) expanded in Alameda County. An evaluation should be done to calculate the overall direct and indirect costs to serve individuals with SMI & SUD. Examine the role of Technology - focus on Technology Infrastructure and Digital Technology BMH must have a robust Technology (IT) Infrastructure. There will be a possible shift from Specialty Mental Health services to using the Medi-Cal model for all services. At the Public Hearing staff also answered questions regarding some of the various programs in the FY19 Annual Update. During the Public Hearing the Mental Health Commission passed the following motion: M/S/C (Posey, Fine) Move to recommend to the City Council to approve the MHSA FY19 Annual Update. Ayes: Castro, Davila, Fine, Heda; Kealoha-Blake, Ludke, Posey; Noes: None; Abstentions: None; Absent: cheema; Ortiz. 11

14 MHSA FISCAL YEAR (FY) 2018/19 ANNUAL UPDATE This City of Berkeley s MHSA FY2018/19 (FY19) Annual Update is a stakeholder informed plan that provides an update to the MHSA 2017/ /20 Three Year Program and Expenditure Plan (Three Year Plan). The Annual Update summarizes proposed program changes and additions, includes descriptions of currently funded MHSA services that are proposed to be continued in FY19, and provides a reporting on FY17 program data. PROPOSED NEW FUNDING ADDITIONS A review of proposed staffing and services to be added through the MHSA FY19 Annual Update, are outlined below: TAY, Adult & Older Adult Full Service Partnership (FSP) The highest level of outpatient case management services available in the adult system of care are through the TAY, Adult, & Older Adult Full Service Partnership (FSP). There is a large demonstrated need for high level wrap around services for individuals with serious mental illness. Each of the positions are being proposed through unallocated CSS FSP funds. 1 Full-Time Equivalent (FTE) Behavioral Health Clinician II - $153,992: The addition of this clinical position will enable the TAY, Adult & Older Adult FSP to better serve existing consumers and increase the program capacity, thereby better supporting the community needs..5 FTE Registered Nurse - $83,212: The addition of a Registered Nurse position will increase the availability of medical supports for consumers in need. Children s Intensive Support Services Full Service Partnership (FSP) Full Service Partnership (FSP) case management is the highest level of outpatient case management service available in the children s system of care targeting children with the highest level of impairment and risk. There is a large demonstrated need for high level wrap around services for children with serious emotional disturbances. This position is being proposed through unspent CSS FSP funds. Senior Behavioral Health Clinician - $167,744: The addition of this position will ensure the Children s FSP has the appropriate level of oversight and support, while also increasing the capacity of this team to serve more children and families. MHSA Administration Per the approved MHSA FY17 Annual Update a project-based Assistant Management Analyst was hired on a short-term basis to support the work of the MHSA Coordinator. With additional MHSA state reporting requirements prompting increasing demands on the MHSA Coordinator, this additional staffing support has proven to be very beneficial to the Division. As such, in 12

15 FY19, BMH is proposing to utilize $131,153 from a combination of unallocated CSS and PEI Administration funds to hire a Full-time Assistant Management Analyst. Flex Funds for Clients Flex Funds are currently used with clients throughout the system to assist with outreach and engagement, and client supports such as housing, clothing assistance, food, transportation, etc. This support aides individuals in achieving better stability in areas where they are less capable of addressing their daily living needs. In FY19, the Division is proposing to utilize $10,000 of unallocated CSS System Development monies to increase the amount of Flex Funds to a total of $30,000 to be utilized for clients in need. Wellness Recovery Center Per previously approved MHSA Plans BMH has allocated $450,000 of CSS System Development funds annually to pool with Alameda County Behavioral Health Care Services (BHCS) monies to fund a local Wellness Recovery Center. In FY16, a Memorandum of Agreement (MOU) with Alameda County BHCS was finalized. BHCS executed a Request For Proposal (RFP) process and Bonita House was the chosen community-based organization who will be implementing the Wellness Center. Bonita House identified a site on University Avenue where the Wellness Center will ultimately be located and construction has begun. In FY18, BMH was notified that construction costs on the Wellness Recovery Center are projected to be more than originally anticipated. Per MHSA statute, (Welfare and Institutions Code, Section 5892(b)): In any year after , programs for services pursuant to Part 3 (commencing with Section 5800), and Part 4 (commencing with Section 5850) of this division may include funds for technological needs and capital facilities, human resource needs, and a prudent reserve to ensure services do not have to be significantly reduced in years in which revenues are below the average of previous years. The total allocation for purposes authorized by this subdivision shall not exceed 20 percent of the average amount of funds allocated to that county for the previous five years pursuant to this section. This legislated allowable use of funds will enable BMH to re-allocate a sum of CSS and/or PEI funds towards technological needs, capital facilities projects, human resource needs, and/or the prudent reserve. Per this legislation and the need for additional funding for the construction of the Wellness Recovery Center, in FY19 BMH is proposing to transfer $750,000 of unspent CSS Funds towards to the Capital Facilities Technological Needs (CFTN) funding component. Transferring funds from the CSS component to CFTN, will enable them to be utilized for construction costs on the Wellness Recovery Center. Once the transfer occurs, the funds will be allocated to the County to cover the City of Berkeley s portion of the additional construction costs on the Wellness Recovery Center. 13

16 Employment Services In the previously approved Three Year Plan funding for an Employment Specialist (1 FTE Social Services Specialist - $132,523) was added through unspent CSS System Development funds. It was envisioned that this position would focus on utilizing an evidenced based model for supporting individuals with serious mental illness in obtaining and retaining competitive employment. The hiring process for this position has not occurred yet, as BMH has been evaluating whether the best use of funds would be to hire the full-time position, or to contract the services out to a local organization that focuses on employment services and supports for mental health consumers. As a decision on the best approach has not been finalized yet, BMH is requesting to have flexibility in FY19, on how the funds previously allocated for an Employment Services Specialist position, will be utilized. Albany Community Resource Center In the previously approved Three Year Plan the City of Berkeley allocated $32,000 of MHSA CSS System Development funds to support the City of Albany Community Resource Center. The Albany Community Resource Center was a short term pilot project that offered residents a one-stop venue to learn about and receive referrals and resources to assist with a range of social and economic needs. The Community Resource Center was staffed by a half-time Community Resource Center Director. In early 2018, due to a loss of staffing the Albany Community Resource Center closed prematurely. During the time the Resource Center was in operation, 54 individuals (30 females, and 24 males) between the ages of 8-87 years old were served. The demographics of individuals served were as follows: 9% African American; 7% Asian; 7% Latino; 33% Caucasian; 2% Mixed; 42% Unknown. The top concerns of those served included housing or homelessness, mental health issues, and medical and/or dental needs. The provision of referrals and assistance for Albany residents were able to continue on an interim basis at the Albany Senior Center by Resource Center volunteers. In March 2018, the Albany City Council authorized the development of a Human Services Resource Linkage Program which will continue the work of the Community Resource Center and will include a full-time Human Services Resource Coordinator. To provide support to this program in FY19 BMH is proposing to allocate a total of $50,000 of PEI Funds to support this program. Additional Services for Asian Pacific Islanders The Asian Pacific Islander population is significantly underserved in the mental health system. In an effort to better meet the needs of this underserved population, BMH is proposing to utilize $100,000 of unallocated CSS System Development funds to contract with a local communitybased organization or partner with ACBHCS to increase funding for a contractor selected for similar purposes.. The contractor will provide access to additional services and supports for this 14

17 population, and if BMH directly contracts with an organization the contractor will be chosen through a competitive Request for Proposal (RFP) process. Russell Street Residence Funding Support The Russell Street Residence provides permanent supportive housing for 21 formerly homeless adults aged 18 and older, who live with severe mental illness. Operated through the Berkeley Food & Housing Project (BFHP) the Russell Street Residence offers residents the following services: 24/7 care; meals; therapeutic groups, activities and outings; transportation to medical appointments; and assistance with daily living activities such as laundry and personal hygiene. Additionally, staff work with residents to support the development of independent living skills. Since the inception of the Russell Street Residence in 2002, BFHP and BMH have been in a partnership relationship, with the City providing funds to support the program. Over the years, the costs of operating this permanent supportive housing program have significantly increased which has created a gap between funding and expenditures. The projected budget for FY19, is $676,231 with a funding gap of approximately $114,000. In previous years, BFHP has covered this gap with cash reserves. However, BFHP reports that continuing to utilize organizational reserves for this purpose is no longer viable. Currently, the City of Berkeley provides a funding amount of $43,045 for this program. In order to ensure this vital permanent supportive housing program is able to continue to be sustained, BMH is proposing in FY19 to begin allocating an additional $114,000 of unallocated CSS System Development funds on an annual basis to BFHP to support the Russell Street Residence. Evaluation Consultant Feedback received over the past couple of years regarding program outcomes has largely focused on implementing evaluative measures that help BMH, MHSA Stakeholders and community members more fully understand and determine how well programs are meeting participant and community needs. Integral to this type of outcome measure is to engage the voice of the program participant around the services they received. Despite best intentions of staff there is simply not the time or expertise to effectively accomplish this and the specialized skills of a consultant will ensure the most successful outcome. In response to this input, BMH is proposing to allocate $100,000 of unallocated CSS System Development funds for a Consultant who will conduct an evaluation on all BMH programs across the system utilizing the Results Based Accountability (RBA) framework. The RBA framework will measure how much was done, how well it was done, and whether individuals are better off as a result of the services they received. The Consultant will be chosen through a competitive RFP process. Innovations Consultant Development of a MHSA Plan includes: community program planning with the involvement of area stakeholders, writing a draft plan, initiating a 30-day public review, conducting a public hearing at the Mental Health Commission meeting, and obtaining approval on the plan from City Council. MHSA Innovation Plans also have the added requirement of approval from the State 15

18 Mental Health Oversight and Accountability Commission (MHSOAC). From the development of an Innovations Plan through all required approvals is often a very lengthy process of 6-8 months or more. As increased work demands have created time constraints for MHSA Administrative staff, in FY19 the Division is proposing to hire a consultant who will conduct all the required steps to ensure the next MHSA Innovations Plan is approved. Per MHSA regulations, a percentage of funds may be used on community program planning activities. As such, in order to provide support on the MHSA INN Plan execution process, BMH is proposing to utilize $50,000 of unallocated monies ($20,000 INN and $30,000 CSS System Development funds) to hire an Innovation Consultant. The Consultant will be chosen through a competitive RFP Process. Dynamic Mindfulness Program (DMind) In FY19, BMH is proposing to allocate $95,000 of unspent PEI funds to support the Berkeley Unified School District (BUSD) Dynamic Mindfulness (DMind) Program. DMind is an evidencebased trauma-informed program that will be implemented in each of the BUSD middle and high schools. Validated by independent researchers as a transformative program for teaching children and youth, skills for optimal stress resilience and healing from trauma, the DMind program integrates mindful action, breathing, and centering into an intervention that can be implemented in the classroom in 5-15 minute sessions, 3 to 5 times a week. This program has proven to be successful with vulnerable students who are exhibiting signs of trauma/ptsd from Adverse Childhood Experiences (ACEs), and/or disengagement from school, chronic absences, and significant behavioral challenges, including emotion regulation, impulse control, and anger management. DMind also enables teacher well-being, which has been shown to enhance student learning. The program components will include in-class and after-school DMind sessions for students, student peer leadership development, training and coaching of school staff, and program evaluation. Mental Health Peer Education Program In response to an identified need by Berkeley High School students, in FY19, BMH is proposing to allocate $92,778 of unallocated PEI funds to support the Berkeley Unified School District (BUSD) Mental Health Peer Education Program. This is a new program in BUSD that will develop and implement a mental health curriculum for 9 th graders and an internship program for a cohort of high school students in an effort to increase student awareness of common mental health difficulties, resources, and healthy coping and intervention skills. Through this program students will be trained by a licensed BUSD clinician to conduct class presentations covering common mental health disorders, on and off campus resources, as well as basic coping and intervention skills. California Mental Health Services Authority (CalMHSA) PEI Statewide Projects In 2009, California s counties formed the California Mental Health Services Authority (CalMHSA) as a Joint Powers Authority to implement PEI statewide program initiatives. With an approved combined funding level of $40 million per year for four years during the timeframe of 2011 through 2015, CalMHSA implemented statewide initiatives in the following areas: Suicide Prevention, Stigma and Discrimination Reduction, and Student Mental Health. Following 2015, funding for PEI Statewide projects was generated through pooled contributions from individual 16

19 counties. Contributing counties are members of a CalMHSA board that provides direction into the types of initiatives that are implemented. In order to continue to sustain programming, CalMHSA previously asked counties to allocate 4% of their annual local PEI allocation each year from FY2018 FY2020 to these statewide initiatives. In the City of Berkeley, this currently amounts to approximately $43,600 a year. Through the previously approved Three Year Plan the City of Berkeley allocated PEI funds for one year towards this statewide initiative, and for the remaining two years, elected to assess on an annual basis whether or not to continue to allocate funds to this initiative. In FY17, through this initiative resources on Suicide Prevention, Student Mental Health and Stigma and Discrimination reached an excess amount of 1400 individuals. Additionally an excess of 1250 pamphlets and resources on Suicide Prevention, Student Mental Health and Stigma and Discrimination were distributed in local schools and the community. BMH also participated in the CalMHSA Each Mind Matters campaign and distributed materials and giveaways at the local May is Mental Health Month event. Part of participation in the CalMHSA Each Mind Matters May is Mental Health Month initiative also enabled BMH to send a group of consumers to a local baseball game. As with last year, in FY19, BMH is proposing to allocate 4% of PEI Funds (approximately $43,600) to CalMHSA to access and participate in the PEI Statewide Program initiative. PROGRAM DESCRIPTIONS AND FY17 DATA BY FUNDING COMPONENT Outlined in this section per each funding component are descriptions of current City of Berkeley MHSA services along with FY17 program data. Across all MHSA funded programs, in FY17, a total of 6,398 individuals participated in some level of services and supports. Additionally, a total of 604 individuals attended BMH Diversity and Multi-cultural trainings aimed at transforming the system of care, and 1,487 individuals attended BMH Diversity and Multicultural events. Some of the FY17 MHSA funded program highlights include: a reduction in psychiatric inpatient hospital and/or incarceration days for severely mentally ill clients; a decrease in the number of days severely mentally ill clients spent homeless; step down to a lower level of care for some clients; services and supports for homeless or marginally housed TAY who are suffering from mental illness; services and supports for family members; consumer driven wellness recovery activities; Housing, and Benefits Advocacy services and supports for clients; augmented prevention and intervention services for children and youth in the schools and community; increased outreach, and support services for homeless TAY, Adults and Older Adults and individuals in underserved and inappropriately served cultural and ethnic populations. 17

20 COMMUNITY SERVICES & SUPPORTS (CSS) Following a year-long community planning and plan development process, the initial City of Berkeley CSS Plan was approved by the California Department of Mental Health (DMH) in September Updates to the original plan were subsequently approved in September 2008, October 2009, April 2011, May 2013, May 2014, May 2015, June 2016, January 2017 and July From the original CSS Plan and/or through subsequent plan updates, the City of Berkeley has provided the following services: Wrap-around Services for Children and their families; TAY, Adult and Older Adult Intensive Treatment Services; Multi-cultural Outreach & Engagement; TAY Support Services; Consumer Advocacy; Wellness and Recovery Services; Family Advocacy; Housing Services and Supports; Benefits Advocacy; and Transitional Outreach Services. Descriptions for each CSS funded program and FY17 data are outlined below: Children s Intensive Support Services FSP FULL SERVICE PARTNERSHIPS (FSP) This program provides intensive short-term, individualized treatment, care coordination, and support to children and youth ages 0-18 years. The main goal of the program is to enable children, youth and their families to acquire the skills and/or mental health supports needed to improve, stabilize, and/or strengthen their levels of individual and family functioning. Program interventions include mental health counseling, parent and child psycho-education, case management, medication management, crisis services, brokerage, and/or stabilization for acute mental health issues. Services are individually tailored, developed in collaboration with families, and incorporate a range of strength-based, culturally competent services and resource acquisition. Program strategies also incorporate a range of services to promote resilience in the child and family, and utilize schools as an important avenue for referrals. This program is structured to serve 20 youth at a time. This in-house FSP provides comprehensive, intensive mental health services for children, youth (0-18) and their families in their homes and/or communities. In FY17, a total of 23 children/youth ranging in ages from 7 to 18 years old were served through this program. Demographics on those served were as follows: 18

21 CLIENT DEMOGRAPHICS N=23 Client Gender Number Served % of total Male 11 48% Female 11 48% Transgender 1 4% Race/Ethnicity Client Race/Ethnicity Number Served % of total African American 13 57% Asian Pacific Islander 0 0% Caucasian 5 22% Latino 4 17% Mixed Race 1 4% TAY, Adult and Older Adult Full Services Partnership This program provides intensive support services to TAY, Adults and Older Adults with severe mental illness using an Assertive Community Treatment approach. The program focuses on serving individuals who are or who have had difficulty with obtaining or maintaining housing; frequent and/or lengthy psychiatric hospitalizations; and/or frequent or lengthy incarcerations. Priority populations also include individuals from un-served, underserved and inappropriately served cultural communities. The team utilizes an Assertive Community Treatment approach which maintains a low staff-toclient ratio (12:1) that allows for frequent and intensive support services. Clients are provided assistance with finding appropriate housing and in some cases may qualify for temporary financial assistance. A full range of mental health services are provided by a team comprised of a Program Supervisor, Clinicians, a Social Services Specialist, a Registered Nurse and a ½ time Psychiatrist. The primary goals of the program are to engage clients in their treatment and to reduce days spent homeless, hospitalized and/or incarcerated. Goals also include: increasing employment and educational readiness; self-sufficiency; and wellness and recovery. The program serves up to 60 clients at a time. During FY17 a total of 64 Transitional Age Youth (TAY), Adults, and Older Adults were served through this program. Demographics on those served include the following: CLIENT DEMOGRAPHICS N=64 Client Gender Number Served % of total Male % Female % Race/Ethnicity Client Race/Ethnicity Number Served % of total African American 35 54% Asian Pacific Islander 6 9% Caucasian 20 31% Latino 3 5% Native American 0 0% Age Category Client Age Category Number Served % of total Transition Age Youth 5 8% Adult 50 78% Older Adult 9 14% 19

22 TAY, Adult and Older Adult client outcomes included the following: 7 partners were dis-enrolled from the program during FY17: 2 partners met treatment goals and graduated to lower levels of care, 1 partner moved out of the county, 2 partners were unable to be located, 1 partner was discharged due to serving a jail sentence and 1 partner died. 11 new partners were enrolled into the program over the course of the fiscal year. There were 64 FSP program participants in FY17, 60 completed a full year of services in the program and are included in the program outcome report data. There were positive outcomes with regard to reductions in days spent homeless, in hospital settings and/or incarcerated. There was a 65% reduction in days spent homeless. Partners spent 5,515 days homeless (on the street, couch surfing and in shelters) the year before the program enrollment and 1,945 days homeless during the first year of program participation. There was an 88% reduction in days spent in psychiatric hospital settings (Psychiatric Emergency, acute inpatient, IMDs, MHRCs and state psychiatric hospitals) during the first year program participation. Partners spent 4,144 days in psychiatric hospital settings the year before program enrollment and 492 days in these settings during the first year of program participation. There was an 83% reduction of days spent incarcerated during the first year of program participation. Partners spent 1,120 days incarcerated (jail and prison) the year prior to program enrollment as compared with 186 days incarcerated during the first year of program participation. While achieving impressive outcomes, the program continues to face challenges. One continued challenge is the difficulty of finding safe, affordable housing in one of the most expensive housing markets in the U.S., especially given that Licensed Board & Cares that provide clients 24/7 support and monitor medication adherence have recently been closing down and Single Room Occupancy Hotels have been raising their monthly rates such that clients are not able to afford staying there without housing subsidies. The program has also struggled with how to better serve individuals with severe substance abuse problems who are unwilling to address or sometimes even acknowledge that they have substance abuse issues. Going forward BMH will continue to develop staff expertise in treating substance abuse disorders by providing ongoing training in Motivational Interviewing. The team will also continue to work on increasing fidelity to the Assertive Community Treatment model. MULTI-CULTURAL OUTREACH AND ENGAGEMENT Diversity & Multicultural Services The Diversity & Multicultural Coordinator (DMC) provides leadership in identifying, developing, implementing, monitoring, and evaluating services and strategies that lead to continuous cultural, ethnic, and linguistic improvements within the organization s system of care, with a special emphasis on unserved, underserved, inappropriately served, and emerging populations. The DMC also collaborates with the state, regional counties, other City divisions, local agencies and community groups in order to address mental health inequities and disparities for targeted populations and communities and the community-at-large in the cities of Berkeley and Albany. 20